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  • Title: Depressive symptoms and Norplant contraceptive implants.
    Author: Westhoff C, Truman C, Kalmuss D, Cushman L, Rulin M, Heartwell S, Davidson A.
    Journal: Contraception; 1998 Apr; 57(4):241-5. PubMed ID: 9649915.
    Abstract:
    Women enrolled in a multicenter prospective study were evaluated to identify any possible relationship between depressive symptoms and the use of contraceptive implants. Women choosing Norplant implants (n = 910) were evaluated before starting this contraceptive and were reinterviewed at 6 months and 2 years. Women who continued the method had lower depressive symptom scores before initiating Norplant implants than did the women who discontinued the method or who were lost to follow up. Among the continuing Norplant implant users, the mean scores were similar before starting Norplant and at 6 months (7.9 vs 7.7). The strongest overall predictor of the depressive symptom score was relationship satisfaction. At 24 months, the subgroup of continuing users with decreased relationship satisfaction had an increase in depressive symptom score, but those with stable or improved relationships had stable depressive symptom scores. The subjects with the highest (i.e., worst) scores at enrollment demonstrated improved scores during follow-up. These results are reassuring for women who are concerned that Norplant use may adversely affect their mood. Although depression is cited in the Norplant contraceptive implant product labeling as a rare side effect, previous evaluations of this association have not included baseline measurement of mood. To assess this association more systematically, the present study followed a cohort of 910 new Norplant acceptors recruited from three urban hospitals in the US (Texas, Pennsylvania, New York) for 24 months. Included in both the initial and follow-up questionnaires were six questions drawn from the Mental Health Inventory on depressive symptoms in the past month. At the end of the study period, 293 women were still using Norplant, 295 had discontinued use, and 138 were lost to follow-up. Women who continued with Norplant for 2 years had significantly lower depression scores at baseline than women who discontinued use or were lost to follow-up. Among continuing Norplant users, mean depressive symptom scores were similar before starting Norplant and after 6 months of use (7.9 and 7.7, respectively). The strongest overall predictor of the depression score was relationship satisfaction. At 24 months, the subgroup of continuing users with decreased relationship satisfaction had an increase in depression score, while those with no change or improved relationships had stable scores. The mean depression score of the quintile of women most depressed at enrollment improved during the study period from 15.4 to 11.0, dispelling concerns that Norplant exacerbates pre-existing depression. Only 4.4% of discontinuers cited mood changes as a reason for terminating Norplant use and there were no cases of psychiatric hospitalization. These findings suggest that concern about possible mood changes is not a reason to withhold Norplant.
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